上海市居家安宁疗护服务阻碍因素分析

目的探索上海市居家安宁疗护服务开展的阻碍因素,明确解决这些因素的优先顺序和可行性,为推动居家安宁疗护服务开展提供参考.方法采用概念图法作为方法学指导:通过质性访谈和文献回顾,探索影响居家安宁疗护服务开展的阻碍因素;对阻碍因素进行分类,并对解决每个因素的优先度和可行性进行评分;通过多维尺度分析和层次聚类分析形成概念图.结...

Identifying the barriers to the delivery of home-based end-of-life care in Shanghai:a concept mapping approach

Objective To identify the barriers to the delivery of home-based end-of-life care in Shanghai, and to rank the priority level and feasibility of solving these barriers, thus to provide reference for advancing home-based end-of-life care. Methods Following the guidance of concept mapping approach, barriers to the delivery of home-based end-of-life care were determined through qualitative interviews and literature review, then priority level and feasibility of solving these barriers were rated by healthcare professionals. Finally, multidimensional scaling and hierarchical cluster analysis were conducted to generate the concept map. Results Fifty healthcare professionals from community health service center or administrative faculty participated in the study. Sixty-one barriers were identified and grouped into five clusters: staff competency and practice setting (mean score of priority=4.93, mean score of feasibility=4.38); service design (priority=5.08, feasibility=4.30); medical expenses and staff rewards (priority=5.62, feasibility=4.40); patient and family attitudes and knowledge (priority=5.07, feasibility=4.27); and miscellaneous barriers (priority=4.42, feasibility=3.69). Conclusion Considering the priority level and feasibility, the issues of medical expenses and staff rewards should be solved first. It is recommended to enact laws or policies, guarantee financial support, establish reasonable charging standards for the service, and enhance reward for healthcare providers, thus to encourage them to engage in home hospice care.